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January 26, Puzzle Piece - Why, What and How Heart Rate Variability Can Double Your Practice

January 26, 2015 Puzzle Piece  


Why, What and How Heart Rate Variability Can Double Your Practice

We just presented the Heart Rate Variability (HRV) work of Dr Michael Kessler at Homecoming.  He has tried to get me to understand the importance of Heart Rate Variability for years.  It wasn't until Clark Tilly of the 3rive company  (who also presented at Homecoming 2015), recently showed me the statistics of doctors that used his testing and reporting system doubled their retention, results and income that I caught the vision.  The 3rive system of evaluating every part of the practice and constantly educating the doctors and the patients proved to me the effectiveness of both HRV and the 3rive system.  Dr Brett Brimhall has added both systems to his office to great success.
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Part 1
The reason why is that heart rate variability (HRV) is a reflection of the autonomic nervous system that controls 90% of the body's functions. The two branches of the autonomic nervous system (ANS) consist of the sympathetic and the parasympathetic.  These two branches regulate the slowing and speeding up of the heart rate through their influence on the SA node of the heart. This is why we can look at an ECG and be able to look at the beat to beat changes between one heart contraction to the next to give an indication of how well the ANS is able to adapt to internal and external stressors. Ultimately, increased HRV means that the time domain between each successive heartbeat shows a variable time between one R wave to the next. This means good autonomic balance and adaptability. Low heart rate variability means that the time domain between each R wave to the next is constant and lacks variability as far as time goes. These are the people that are stuck in either sympathetic or parasympathetic tone and have lost their ability to adapt. When we talk about time domain, it is visualized as something called a rhythmogram that we construct from the ECG. What's interesting is that the heart appears to beat very evenly. This is not the case. Usually the difference between the shortest and the longest cardiac cycles of a healthy person is 250 milliseconds. This is called the variational range. Research shows those that lack this variation or what we call low HRV are the ones that are more prone to having a Myocardial Infarction (MI) on Monday morning at work.

If we turn the R to R waves vertically we make a diagram called the rhythmogram that allows us to get a good visual on the adaptive capabilities of the autonomic nervous system. With the diagram below you can see a quickening of the heart rate, the curve of the rhythmogram goes down and with a deceleration of the heart rate it goes up. This is a consequence of the regulatory systems of the body influencing these changes. This way you can see the body responding to the needs of the organs and systems and the heart changing to meet those needs.
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The other key components of heart rate variability are Low frequency, High frequency, Very Low Frequency, Stress Index, Vital force and Standard Deviation of Normal to Normal beats (SDNN). Once we explain these concepts you will be a connoisseur of HRV. There are three regulatory systems that can be decoded from a technique called Fast Fourier Transform which reflects how often waves of a definite length appear on the ECG. The graph obtained from this procedure is called a spectrogram. Basically we break down the ECG into its frequency component band widths that correspond to specific regulatory systems. A good analogy for Fast Fourier Transform is a prism that separates the complete light spectrum into its individual color frequency bands. LF or low frequency corresponds to sympathetic nervous system regulation and HF or high frequency is about parasympathetic regulation. VLF is about the central nervous system (CNS) and its regulation through its downstream hormones.

Before we discuss the clinical implications of LF, HF, and VLF we need to discuss the stress index. The stress index is a common mathematical value found in some HRV systems and tells us how hard the autonomic nervous system has to work to maintain balance. If it is out of the normal range and high, it is like driving your car without a thermostat and eventually the engine is going to heat up and seize. Another standard HRV value is the SDNN. This stands for Standard Deviation of Normal to Normal beats. This is the most common index of overall HRV. This reflects the ability to respond quickly, dynamically and effectively to a stressor. The last index is vital force and tells us how much fuel that patient has in their engine. If it is low, it is a good indication to use gentle therapies or detoxification so the patient isn't pushed over their capacity to tolerate the treatment.

In the next installment we will discuss all the other important information derived from heart rate variability such as cardiovascular adaption, autonomic nervous system regulation, neurohormonal regulation, psychoemotional state3 and show how it all ties together. In the research coming out of Russia there are very provocative studies on using HRV to give indications of thyroid balance or imbalance4, brain function indirectly from HRV as well as very accurate information about the meridians from Chinese and more. Once you understand the basics, I will show you cases that will tie all the information together in a seamless fashion. In private practice an advanced HRV model will allow you to know if the therapies you are using are improving your patients health, or if their health is staying the same or getting worse.


1.  Sandercock, Gavin Richard H., Brodie, David, The Role of Heart Rate Variability in Prognosis for Different Modes of Death in Chronic Heart            Failure, Buckinghamshire Chilterns University College, Chalfont St. Giles, UK, 2006; 29: 893-904.

2.  Bayevsky, R.M, Ivanov, G.G, Chireykin, L.V, Gavrilushkin, A.P., et al, HRV Analysis Under the Usage of Different Electrocardiography                   Systems (Methodical Recommendations), Committee of New Medical Techniques of Ministry of Health of Russia, 2002; 4:  2-67.

3.  Tonhajzerova, Ingrid, Ondrejka Igor, Turianikova, Zuzana, Javorka, Kamil, et al, Heart Rate Variability:  An Index of the Brain-Heart Interaction,        Tachycardia, 2012: 185-202.

4.  Moldabek, Gulnar, Heart Rate Variability Indicators in Patients with Hypothyroidism, Medical and Health Science Journal, 2011; 6: 127-131.

You can find out more information through our office by calling or e-mailing Jason at 866-338-4883 or [email protected]<mailto:[email protected]>.  We will be doing webinars with Dr Kessler as well!

Click Below To View The HeartQuest Webinar
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Yours in Health and Wellness,
John W. Brimhall, BA, BS, DC, FIAMA, DIBAK

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